Health Insurance Options for Veterans

As we continue to celebrate National Veterans and Military Families Month, I am reminded of a quote from President Obama: “It’s about how we treat our veterans every single day of the year. It’s about making sure they have the care they need and the benefits they’ve earned when they go home.”

According to a 2021 report by the Interagency Veterans Advisory Council, about 500,000 military veterans currently work as civilian federal employees in the government. Retired military personnel who are currently working or have retired from federal civilian employment receive a special set of health benefits.

Retired military members are generally eligible for TRICARE health insurance. Other ex-servicemen usually aren’t, with one notable exception: Medal of Honor recipients and their families. Reserve Component benefits are a bit more difficult to navigate because eligibility rules and plan options are based on a military member’s service status, which can change many times throughout their career.

There are two main types of TRICARE beneficiaries: sponsors (active, retired, and members of the Guard and Reserve) and family members (spouses and children enrolled in the Defense Enrollment Eligibility Reporting System). Unmarried biological children, adopted children, and stepchildren are eligible for TRICARE until age 21 (or 23 if in college). TRICARE covers nearly 10 million current and former military members and their dependents.

According to the Military Benefits Association, there are the following types of TRICARE benefits available to retired military personnel and their families:

These plans offer generous coverage for medical care and prescriptions with relatively low out-of-pocket costs. TRICARE has a health maintenance organization and preferred provider options. Health benefits advisors are available to provide information about the plans to authorized personnel and beneficiaries.

TRICARE and FEHB

The option to use TRICARE, the Federal Employees Health Benefits Program, or both is available to federal employees who qualify for TRICARE. If you are covered by TRICARE and FEHB, the FEHB plan will pay first and TRICARE will be the second payer. If you are employed and also enrolled in Medicare, then the primary payer will be FEHB with Medicare as the secondary payer. TRICARE pays last.

If you are enrolled in an FEHB plan on the date of your retirement from federal civilian employment, you can continue FEHB coverage until retirement. Once you retire, you can suspend your FEHB coverage, but you can lift the suspension during any future open season. See the information below about stopping FEHB coverage at retirement. TRICARE coverage meets the requirements of the five-year test for continuing FEHB coverage at retirement as long as you are enrolled in an FEHB plan at the date of retirement.

TRICARE for life and medical care

TRICARE For Life is comprehensive Medicare coverage if you are eligible for TRICARE and have Medicare Part A and B. You can get health care services from participating and non-Medicare providers, as well as providers who have opted out of Medicare.

As the primary payer, Medicare approves health care services for payment. If Medicare doesn’t pay because it decides the care isn’t medically necessary, neither does TFL. You can appeal Medicare’s decision and if Medicare reviews and grants coverage, TFL also reviews coverage. If a health service is covered by both Medicare and TFL, but Medicare won’t pay because you’ve used up your Medicare benefit, TFL becomes the primary payer. In this case, you are responsible for the TFL deduction and cost shares.

If TFL is the primary payer, you must visit TRICARE-authorized providers and facilities. You will have significant out-of-pocket costs when you receive care from providers who opt out. Veterans Affairs providers cannot bill Medicare, and Medicare cannot pay for services obtained from the VA. If you are eligible for both TFL and VA benefits, you will have significant out-of-pocket costs when you see a VA provider for health care that is not related to a service-connected injury or illness. To learn more about TFL benefits and coordination with Medicare, see the TFL Handbook.

Federal employees who turn 65 before retirement can use one of the FEHB plans and wait to enroll in TFL and Medicare Part B at retirement by using the special enrollment period for Part B. If you decide to delay enrolling in Part B and rely solely on employer-sponsored coverage, enroll in Part B before you retire or during your special enrollment period. Your TFL coverage starts the first day you have Medicare Part A and Part B coverage.

Other health insurance

If you have any health insurance other than TRICARE, it’s called “other health insurance” or OHI. This can be Medicare or employer-sponsored health insurance such as FEHB. By law, TRICARE pays after all other health insurance, with a few exceptions, such as Medicaid or TRICARE supplements. This means that your OHI processes your claim first. Then you or your doctor submit your claim to TRICARE.

FEHB Open Season

This year’s FEHB open season runs from November 14th to December 12th. If you’re enrolled in FEHB, whether you’re actively employed or retired, take advantage of this annual event to reevaluate your health coverage to make sure you’re in a plan that’s both cost-effective and comprehensive. OPM reminds everyone that unexpected accidents and illnesses can be costly. Even routine doctor visits and prescriptions can add up.

Thank you to all veterans who have served our nation – and in some cases continue to serve as civilian federal employees. Do yourself and your family a favor by learning about your insurance benefits so you can continue to protect yourself and your loved ones.

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